护士分层级管理在NICU中的应用

目的探讨NICU分层级管理的方法和效果，以充分发挥各层次护士作用。方法2007年1月-2007年12月采用传统排班，2008年1月至2008年12月期间实施连续性排班，设置护理组长、责任护士及助理护士岗位职责，进行分层级管理及使用，比较分层级管理前后护士满意度、医生满意度以及实习护生满意度。结果（1）分层次管理实施前后22名护士对护士之间的团结合作性、工作积极性、工作效率等9方面满意度评分比较，差异具有统计学意义（P〈0．01），实施分层次管理后护士满意度评分明显提高。（2）实施分层次管理后医生在执行医嘱及时性和及时准确发现患儿前瞻性信息等5方面满意度明显提高（P〈0．01）。（3）实施分层次管理后实习护生在自我管理能力和学习积极性等5方面满意度明显提高，差异具有统计学意义（P〈0．01）。结论实施分层级管理充分体现高年资护士的职业价值，对低年资护士起到了传帮带的作用，同时也减轻了年轻护士独立上班时的精神压力，利于护士成长；深入了解患儿病情，更快落实医生治疗方案，确保医疗护理安全，利于建立和谐医护关系；激发护生学习积极性，利于培养护生临床思维能力。

Application of tiered nursing management in neonatal intensive care unit

Objective To exlpore the methods and effects of tiered nursing management in Neonatal Intensive Care Unit （NICU）. Methods From Jan. 2007 to Dec. 2007, the traditional integrated nursing management was adopted. From Jan. 2008 to Dec. 2008, the continuous scheduling mode was put into practice with the tiered system in which the nurses were divided into group leaders, duty nurses and assistant nurses. Then a comparison was made of the nurses＇ the physicians＇ and the nurse students＇ satisfaction before and after the introduction of tiered managing system. Results （ 1 ） The difference in 22 nurses＇ assessment of 9 aspects, such as their work solidarity, initiative and efficiency before and after the adopting of the tiered system was statistically significant （P 〈 0. 01 ）, with the nurses＇ satisfaction increasing markedly after the tiered management. （2） The difference in the physicians＇ assessment of 5 aspects, such as their timeliness of implementing orders and realizing patients＇ informarion before and after adopting of the tiered system was statistically significant （ P 〈 0.01 ）, with the physicians＇ markedly increasing satisfaction. （3） The difference in the nurse students＇ assessment of 5 aspects, such as their self- management and study initiative before and after adopting of the tiered system was statistically significant （ P 〈 0.01）, with the nurse students＇ markedly increasing satisfaction. Conclusion Tiered nursing management brings the senior nurses＇ professional values into play, relieving the junior nurses＇ stress and promoting their development. It helps improve nursing efficiency and ensures nursing safety. It also helps to stimulate the nurse students＇ motivation and develop their clinical thinking.